Overdiagnosed: Making People Sick in the Pursuit of Health 1st Edition
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“One of the most important books about health care in the last several years.”—Cato Institute
"One of the big strengths of this relatively small book is that if you are inclined to ponder medicine's larger questions, you get to tour them all. What is health, really?... In the finite endeavor that is life, when is it permissible to stop preventing things? And if the big questions just make you itchy, you can concentrate on the numbers instead: The authors explain most of the important statistical concepts behind evidence-based medicine in about as friendly a way as you are likely to find."—Abigail Zuger, MD, The New York Times
"Overdiagnosed —albeit controversial—is a provocative, intellectually stimulating work. As such, all who are involved in health care, including physicians, allied health professionals, and all current or future patients, will be well served by reading and giving serious thought to the material presented."─ JAMA
“Everyone should read this book before going to the doctor! Welcome evidence that more testing and treatment is not always better.”─ Susan Love, MD, author of Dr. Susan Love’s Breast Book
“This book makes a compelling case against excessive medical screening and diagnostic testing in asymptomatic people. Its important but underappreciated message is delivered in a highly readable style. I recommend it enthusiastically for everyone.”─ Arnold S. Relman, MD, editor-in-chief emeritus, New England Journal of Medicine, and author of A Second Opinion: Rescuing America’s Health Care
“This stunning book will help you and your loved ones avoid the hazards of too much health care. Within just a few pages, you’ll be recommending it to family and friends, and, hopefully, your local physician. If every medical student read Overdiagnosed, there is little doubt that a safer, healthier world would be the result.”─ Ray Moynihan, conjoint lecturer at the University of Newcastle, visiting editor of the British Medical Journal, and author of Selling Sickness
“An ‘overdiagnosis’ is a label no one wants: it is worrisome, it augurs ‘overtreatment,’ and it has no potential for personal benefit. This elegant book forewarns you. It also teaches you how and why to ask, ‘Do I really need to know this?’ before agreeing to any diagnostic or screening test. A close read is good for your health.”─ Nortin M. Hadler, MD, professor of medicine and microbiology/immunology at University of North Carolina at Chapel Hill and author of Worried Sick and The Last Well Person
“We’ve all been made to believe that it is always in people’s best interest to try to detect health problems as early as possible. Dr. Welch explains, with gripping examples and ample evidence, how those who have been overdiagnosed cannot benefit from treatment; they can only be harmed. I hope this book will trigger a paradigm shift in the medical establishment’s thinking.” —Sidney Wolfe, MD, author of Worst Pills, Best Pills and editor of WorstPills.org
About the Author
Dr. H. Gilbert Welch is a renowned authority on the effects of medical screening who has appeared on The Today Show, CNN, NPR, and in the New York Times and Washington Post. He and his coauthors, Dr. Lisa M. Schwartz and Dr. Steven Woloshin, nationally recognized experts in risk communication, are professors at the Dartmouth Institute for Health Policy and Clinical Practice.
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My 93-year-old father has now outlived 2 doctors who insisted he needed statins because his "bad cholesterol" was abnormal even though his ratio was less than 2. And my mother died as the result of a car accident at the age of 85 after having been urged for 20 years to have a hysterectomy because there was a "shadow" on her uterus...a shadow which was discovered when they were treating her for something else. There's a whole chapter in the book on "incidentalomas" ie things high-powered imaging machines can discover when they're looking at something else. These discoveries have a way of cascading into treatments that sometimes injure and even kill people.
Every chapter resonated with me. I'd found it when I was googling to understand why my Fasting Blood Sugar of 104 was healthy in 2002, but now was considered "prediabetic." At least, it is in the U.S. where the American Diabetic Association unilaterally moved the range of normal.
All I have to do is move to Canada if I want to be cured.
What I wish was in this book, what I found missing, was Dr. Welch's guidelines for finding a doctor who will treat me like a human being, not a product to be milked for profit in a clinical factory. How can we find caring practitioners? Dr. Welch, please write another book on this very important subject.
I would highly, highly recommend that every person without a caring physician read this book. Thank you, Dr. Welch, for writing it. And I should add that Dr. Welch is not a "holistic" healer, but a practicing MD who teaches at Dartmouth Medical College. But I am so disenchanted by and even afraid of current doctors that I might seek out just such a "holistic" healer, one who actually practices that old first rule of medicine: do no harm. Better that than paying a small fortune to have a traditional doctor make you sick.
After reading H. Gilbert Welch's book, I have the data that confirmed my hunch. But I approached it with an open mind, as I do most of the media reports I've read about screening recommendations and the newest guidelines for who should take statins, when they should begin, etc. I try to be willing to listen to the real medical people and researchers. But I often get the nagging sensation that somewhere, years in the future, a meta analysis will come out disputing their current guidelines. It's certainly happened often enough in history.
So reading Dr. Welch, as he walks the reader through a careful analysis of the guidelines; a review of the evidence, including an explanation of what the statistics really say; and an explanation of the harms that overdiagnosis can cause, is refreshing and eye opening.
According to the good doctor, overdiagnosis is a long recognized problem in the medical field and it can lead to over-treatment of conditions that might never cause symptoms or harm the patient. But the treatment can, and often does, have side effects, some of which can have lifelong negative impact on the patient's health. Some of which can even lead to death.
Dr. Welch takes readers through a real analysis of cost versus benefit of screening and early and aggressive treatment of patients. He also presents a balanced view of the real risks that go both ways. He doesn't sugarcoat the risk that can come from deadly diseases like cancer. And he admits that there are times that catching a tumor when it is smaller and before it has spread leads to significantly better outcomes. The problem, though, is that many tumors are not deadly and will never grow or be threatening. But nobody can know which will tumors will be aggressive and deadly. So, once they are discovered, through screening, doctors often feel obligated to treat them all with equally aggressive treatments. An aggressive approach to a deadly cancer may be medically justified, but the same approach to one that may be dormant and never cause a problem is not justified, especially if it contains serious risks to life and health. The problem is with early screening you catch more of both types of anomalies and can't know the difference.
Dr. Welch argues that, in fact, while more cancers are diagnosed earlier, the rate of death has not gone down. You may have many seeming cures, but if the death rate has not been altered, it could just mean that more cancers that were never deadly have been overdiagnosed and treated, with accompanying unnecessary risks to the patient.
He does not advocate no screenings. In most cases, he suggests learning all the facts, weighing the risks, discussing it with one's doctor, and making informed decisions about when to be screened. He is neither anti-science nor opposed to traditional, Western medicine. He is a doctor whose own practice follows standard, modern protocols. And he uses his research knowledge to back up his claims with solid data. He also intersperses his arguments with personal anecdotes that demonstrate his arguments. But the anecdotes do not take the place of data, on which he spends most of the book.
Some of it gets repetitive and I found myself skimming toward the end when he seemed to be repeating his arguments over and over again. That is because he goes into great depth of analysis on a variety of different cancers that are screened for and the evidence always turned up the same facts, that too aggressive screening led to overdiagnosis, aggressive treatment, and potential harms, over and over again.
This is a great book to get a balance view from a doctor who practices traditional, conservative Western medicine and who has been a researcher with the U.S. Preventive Health Services, the group responsible for many of the revisions to the screening guidelines that made headlines in 2009. Read Dr. Welch's books, talks to your doctor, and make more informed choices regarding your health.
Top international reviews
Yet the downside is that the author is often hypocritical, relying on sparse statistics to back up his argument when available and powerful anecdotes otherwise, often the case for over-diagnosis (particularly in the beginning) is not quantified adequately, despite his criticisms against the pro-over-diagnosis bodies using exactly the same systems to their end. He often comes across as too close to being against medical intervention regardless, such as his statement regarding the woman suffering from symptomatic thyroid cancer on p.140.
Overall a well written and informative read.
Unlike most of this genre does not blame big pharma, but many other tragetsincluding doctors themselves.